床旁肺部超声在重症和危重症 COVID-19 肺炎中的价值。

Value of Bedside Lung Ultrasound in Severe and Critical COVID-19 Pneumonia.

机构信息

Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.

出版信息

Respir Care. 2021 Jun;66(6):920-927. doi: 10.4187/respcare.08382. Epub 2021 Mar 23.

DOI:10.4187/respcare.08382

PMID:33758057

Abstract

BACKGROUND

Lung ultrasound (LUS) is an effective imaging modality that can differentiate pathological lung from non-diseased lung. We aimed to explore the value of bedside LUS in patients with severe and critical coronavirus disease 2019 (COVID-19)-associated lung injury.

METHODS

Sixty-three severe and 33 critical hospitalized subjects with COVID-19 were enrolled in this study. Bedside LUS was performed in all subjects; chest computed tomography was performed on the same day as bedside LUS in 23 cases. The LUS protocol consisted of 12 scanning zones. LUS score based on B-lines and lung consolidation was evaluated.

RESULTS

The most common abnormality of LUS was the various forms of B-lines, detected in 93 (96.9%) subjects; as the second most frequent abnormality, 80 (83.3%) subjects exhibited lung consolidation, mainly located in the posterior lung region. Twenty-four (25.0%) subjects had pleural line abnormalities, and 16 (16.7%) had pleural effusion; 78 (81.3%) subjects had ≥ 2 abnormal LUS patterns, and 93 (96.9%) had bilateral lung involvement. The proportion of bilateral or unilateral lung consolidation and pleural effusion in the critical COVID-19 group were higher than that in the severe group ( < .05). The lung consolidation of critical subjects showed a marked increase in most lung areas, including bilateral lateral lung, posterior lung, and left anterior-inferior lung area. The median (interquartile range) LUS scores of critical cases were higher than those of severe cases: left: 14 (12-17) vs 7 (5-12); right: 14 (10-16) vs 8 (3-12); bilateral: 28 (23-31) vs 15 (8-22) ( < .001 for all). There was a good correlation between the LUS score and the chest computed tomography score (r = 0.887, < .001).

CONCLUSIONS

The most common abnormal LUS pattern in subjects with severe and critical COVID-19 pneumonia was B-lines, followed by lung consolidation. Bedside LUS can provide important information for pulmonary involvement in patients with COVID-19.

摘要

背景

肺部超声（LUS）是一种有效的成像方式，可以区分病理性肺部和非病变性肺部。我们旨在探讨床边 LUS 在严重和危重症 2019 冠状病毒病（COVID-19）相关肺损伤患者中的价值。

方法

本研究纳入了 63 例严重 COVID-19 住院患者和 33 例危重症 COVID-19 住院患者。所有患者均进行床边 LUS 检查，其中 23 例患者在同一天进行了床边 LUS 检查。LUS 方案包括 12 个扫描区。评估基于 B 线和肺实变的 LUS 评分。

结果

最常见的 LUS 异常是各种形式的 B 线，93（96.9%）例患者存在；其次是肺实变，80（83.3%）例患者存在，主要位于肺后部。24（25.0%）例患者胸膜线异常，16（16.7%）例患者存在胸腔积液；78（81.3%）例患者存在≥2 种异常 LUS 模式，93（96.9%）例患者存在双侧肺部受累。危重症 COVID-19 组双侧或单侧肺实变和胸腔积液的比例高于重症 COVID-19 组（<0.05）。危重症患者的肺实变在大多数肺区均明显增加，包括双侧外侧肺、后部肺和左侧前下肺区。危重症患者的中位（四分位距）LUS 评分高于重症患者：左侧：14（12-17）比 7（5-12）；右侧：14（10-16）比 8（3-12）；双侧：28（23-31）比 15（8-22）（所有 P<0.001）。LUS 评分与胸部 CT 评分之间具有良好的相关性（r=0.887，<0.001）。